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Royal College Studying > Adolescent Medicine > Flashcards

Adolescent Medicine Flashcards

(74 cards)

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1
Q

What is the average age of first intercourse in Canadian Teens

A

16.5

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2
Q

Age of sexual consent in Canada

A

16
14-15 can consent with someone 5 years older
12-13 with 2 years old
( Must not be position of authority)

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3
Q

What is recommended first line contraception

A

Long acting reversable contraception (IUDS!)

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4
Q

What is the typical use failure rate for IUDS

A

0.2% for hormonal, 0.8% for copper

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5
Q

Typical use failure rate for OCP, depo

A

6% of depo, 9% for combined and progesterone only pill

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6
Q

Typical use failure rate for male condoms and withdrawal

A

21% for condoms, 22% for withdrawal

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7
Q

What is the failure rate for OCP plus condom

A

2%

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8
Q

How does progrestin cause contraception

A

Thickens cervical mucus
alter tubal transport time
inhibit ovulation

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9
Q

What are drugs that CAUSE contraception to fail

A

anticonvulsants- carbamazepine, phenobarb, phenytoin, topiramate
antivirals
antifungal
RIFAMPIN
st jonhs wart

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10
Q

What are drugs that fail due to OCPs

A

lamotrigine
salicylic acid
parecetamol
morphine

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11
Q

Drugs that dont interact with OCP

A

valproic acid
ethosuximide
keppra
clonazepam
pregabalin

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12
Q

Absolute CI to OCP

A

uncontrolled HTN (systolic > 160 and diastolic>100
current or past history of VTE (stroke, PE, MI)
ishcemic heart disease
complicated valuvalr heart disease
migraine headache with aura
breast cancer (current)
diabets WITH complications
severe cirrhosis
liver tumor

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13
Q

Absolute contraindication to progestin only pill

A

Breast cancer within the last 5 years

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14
Q

What to do if you mised 1 birht control pll

A

Take as soon as remember, no back up needed

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15
Q

What to do you if you miss 2 birth contorl in a row

A

Use back up
Take 2 pills the day you remember

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16
Q

What to do you if you miss 3 birth contrl pills in a row

A

Start a new pack, use back up

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17
Q

What dose of estradiol do you recommend for OCP

A

30-35 mcg because below 30 associated with poorer bone mineralization in youth

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18
Q

Is a preg test mandatory before emergency contraception

A

No

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19
Q

Whats the most frequently reported STI in Canada

A

Chlamydia

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20
Q

Fitz hugh Curts syndrome

A

RUQ pain
fever
nausea
vomiting
Usually caused by chlamydia

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21
Q

Reiter Syndrome

A

sexually acquired reactive arthritis
chlamydia
male
1mo post chlamydia infection
arthritis, rash on soles and penis, conjunctivitis

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22
Q

STI risk factors

A

under 25
no condom use
contact with someone known to ahve sti
new partern
over 2 partners in last year
serial monogamy
IVDU
any drug use
previous TI
sex workers
survival sex
street involvement
anonymous sex
sexual assault

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23
Q

Who should you screen for C + G

A

all sexually active under 25 regardless of rf
once er year, more often if risk factors
every 6mo if previous infection

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24
Q

What all should you screen for in a sexually active youtih with no other risk factors

A

C and G
syphyllis
HIV

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25
When to collect NAAT for test of cure
wait 2-3 weeks agter treatmnet
26
how to treat a patient with STI symptoms
empirically ceftriaxone 250mg IM single dose plus azithromycin 1g PO single dose
27
preferred chlamydia treatment
azithro 1g PO once OR Doxy 100mg PO BID for 7 days
28
Gonorrhea treatment
Have to treat for chlamydia too Ceftriaxone 250mg IM once PLUS azithro 1g ONCE Cefixime 800mg po once pLUS azithro 1g ONCE
29
When to do follow up testing for C and G
C- NAAT 3-4 weeks post treatment, recommended when compliance is uncertain, second-line treatmen twas used, re-expsure risk is high, pregnant G- culture 3-7 days post treatmnet or NAAT 2-3 weeks post treatmnet IF complicance uncertain, second line, high re-exposure risk, pregnant, antimicrobial resisttance is a concern, previous treatmnet failure, pharyngeal or rectal infection, infection isdisseminated, persistent signs and symptoms
30
What is more likely to have resistnace C or G
C- rare G- resistance emerging
31
Partner notification for C and G
All parterns withint 60 days priro to symptoms onset or if no symptoms then from time of specimen collection
32
How long to abstain from sexual activity after treatmnet for C and G
C: once symptoms have resolved 7 days post single therapy or after completion of multiple dose treatment G: 3 days after single treatment and after symptoms have resolved
33
What percent of PID is due to STIs
80%
34
RF for PID
young adults (20-24), cervicits with C/G, high risk sexual behaviors (unprotected, frequent, multiple, during menses, smoking/alc/drug use, before age 15-16), previous PID, black, BV, menses
35
Do contraceptives increase risk for PID
NO oral OCP increases risk for C possibly G not PID IUD risk following insertion is low even if they have cervicitis, generally restricted to first 3 weeks after insertion
36
Diagnostic criteria for PID
sexually active adolescents with pelvic/lower abdo pain, no other cause for illness identified, one or more of cervical motion tenderness, uterine tenderness, adnexal tendnerness NOT required but supportive fever, abnormal discharge, abundant WBC in vaginal secretions (absence has NPV of 95%), elevated serum WBC, ESR, CRP, positive STI culture
37
Gold standard for PID diagnosis
laparoscopy abnormality consistent with PID +/- endometrial niopsy with evidence of endometritis
38
Does a normal US rule out PID
no
39
When to do an US in PID work -up
Not routinely indicated Can do if the patient refuses gyne exam, adnexla mass is felt, adnexal pain and markedly elevated inflam markers, high fever, elevated WBC, other diagnosis suspected, positive BHCG, hospitalization
40
When to admit PID
surgical emergency cannot be xcluded pregnnacy no response to outpatient treatment after 48-72h patient unable to tolerate oral regimen severe illness, nausea, hgih fever UOA immunosuppression
41
Recommended outpatient treatmnet for PID
ALWAYS 14 days of antibiotics Ceftriaxone 250mg IM in a single dose OR other third gen cephalosporin PLUS dox 100mg BID for 14 days +/- flagyl 500mg BID for 14 days
42
Inpatient treatment for PID
Cefoxitin 2gIV every 6 hours Doxy 100mf oral or IV q12h for 4 days OR clinda 9000mg IV every 8 hours + gent
43
What are acute complications of PID
peritonitis perihepatitis (fitx hugh curtis) TOA adhesions
44
What are longterm complications of PID
recurrent PID infertility ectopic chronic pelvic pain
45
Does BV cause PID
NO- it is a risk factor but is not causative
46
Risk factors for dysmenorrhea
age < 30 smoking low BMI earlier menarche longer cycles hevy flow psych symptoms ovulatory cycles higher levels of prostaglanding in endmetrium family history ?
47
#1 cause of school absenteeism
dysmenorrhea
48
What is first line treatment for dysmenorrhea
NSAIDs 80% respond
49
What of OCP helps with dysmenorrhea
estrogen component
50
effective treatments for endometriosis
OCP depo IUD hormonal gnrh agonists
51
Definition of primary amenorrhea
no menses by age 14 without secondary sex characterisitics No menses by age 16 with secondary sex characterisitics
52
Ddx for amenorrhea with withdrawal bleed after progesterone admin
PCOS or hypothalamic/pit dysfunction Do prolactin/TSH Androgen levels
53
Ddx negative withdrawal bleed
Ovarian insuffiency or hypothalamic DO LH and FSH If high- thinking OI if normal or low- mRI brain
54
Complications of PCOS
infertliy metabolic syndroem (independent of BMI) unopposed estrogen increased risk for endometrial cancer (x3) and breast cancer (x3)
55
Who is at incrased risk for refeeding
Low weight on admission (>70% median BMI) rapid weight loss young age
56
treatment for anorexia
family based therapy
57
What is treatment for bulimia
fluoxetine is the onyl medication approved antidepressant and CBT superior to either alone
58
indications for admission in eating disorder
severe malnutrition (<75% median BMI), dehydration, electrolyte abn, ecg abn, severe vrady <50, hypotension, hypothermia (<35.5), orthostatic changes, failure of otpatient treatment, syncope, seizures, acute food reguslal, uncontrollabel binging nad purging, psych ermgencies
59
What percent of kids have tried alcihol by end of high school and drugs
70% alcohol 50% illicit drug 25% drug other than weed
60
RF for smoking
low education aspirations low self esteem risk taking minimized perceived hazards of smoking favourable attitude towards smokiing peer, parent, sibling smoking lower SES or parents educational attainmnet history of abuse exposure to tobacco media accessibility and price of tobacco products girls: weight control boy: sense of adventure/daring
61
Are e cigarettes effective to help quite smoking
no
62
best evidence for smoking cessation
brief counselling CBY phone or distance counselling
63
risk factors for alcohol use
early puberty in girls parental alcoholism (4-10x) parental drinling standards early onset etoh (<14y) media of alcohol social norms societal provision of alcohol
64
CRAFT screening for alchol
CAR RELAX ALONE FORGET FRIEND TROUBLE
65
AE of anabolic steroids
psych- psychosis, mood swings, aggressive, violence, neurotixicity, body dysmorphia CV_ low HDL, high LDL, HTN, MI, death endo- premature epihpyseal closure, short, female virilization and hypogonadism, decreased libido, infertility, testiuclar atrophy, gynecomastia and high voice acne, prostate enlargement, hepatocellular carcinoma, other illict drugs, hemolysis
66
Acute AE of marijuana use
anxiety/panic, psychotic symptoms, high risk behavior (MVA) increased hR< dry mouth, orthostatic hypotension, supine hypertension, red eyes, CI, processing difficultieis
67
physiologic effects of chronic cannabis use
chronic bronchitis i,paired resp function res cancers gynecomastia
68
Cannabis withdrawl syndrome
at least 2 of : irritability, anxiety, depression mood, sleep disturbance, appetite changes at least 1 physical symptoms: abdo pain, shaking, fever, chills, headache symptoms occur 24072h after cessation of heavy cannabis use, duration 1-2 weeks Treatment: no meds, cognitive and behavioral skills to manage withdrawal and avoid relapse
69
Factors that protect against suicide
reasons for staying alive postivie relationship with at least one parent cultural or religious beliefs adequate parental monitoring and supervision proscoial peer group strong connection to school
70
what medical conditions are associated with suicide
insomnia pain CNS conditions- migraine, epilepsy infalmmatory- IBD, asthma, obesity TBI- esp in military populations
71
RF for depression
female, older, parent/fam hx, comorbid chronic illness (ADHD, DM, anxiety), past history of depression, learning disorder, genetics, certain medications (steroids, isotretinoin), substance use famly or peer conflict, childhood neglect or abuse, poverty, recent loss, academic difficulties or school failure, discrimination and socal exclusion, poo home school relationships, poor quality neighbourhoods
72
Common SSRI AEs
GI symptoms sleep disturbance restlessness headaches appetite changes sexual dysfunction
73
Does presence of substance use do preculude SSRI treatment
no
74
ECG findings in ANR
Bradycardia Low voltage changes Prolonged QTc interval T-wave inversion ST segment depression

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